Neuromonitoring of recurrent laryngeal nerve using continuous intraoperative neuromonitoring system during anterior cervical spine surgery: A porcine model study

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-06-26 DOI:10.1016/j.jocn.2025.111427

Dong Suk Kim , Tae Sik Goh , Yoon Jae Cho , Jung Sub Lee

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引用次数: 0

Abstract

Purpose

Recurrent laryngeal nerve (RLN) injury is a recognized complication of anterior cervical spine surgery (ACSS), particularly during anterior cervical discectomy and fusion (ACDF). This study explores the use of continuous intraoperative neurophysiological monitoring (CIONM) with an endotracheal electromyography (EMG) tube during ACSS in a porcine model, focusing on adverse EMG signal events during retraction and the differences in RLN injury and recovery between surgical levels and approach side (left or right).

Materials and methods

All 12 pigs were intubated with an EMG-equipped endotracheal tube. All surgical procedures were performed via an anterior approach. RLN injury caused by traction was assessed in four segments (C3/4, C4/5, C5/6, C6/7) on both sides, respectively. Laryngeal EMG was continuously measured through electrical stimulation of the vagus nerve using automatic periodic stimulation with CIONM. During surgery, an alarm was set to activate if the EMG amplitude decreased by more than 50% or latency increased by more than 10%, indicating nerve injury. When the alarm was triggered, traction was stopped, and EMG changes were observed. Traction time and recovery time were recorded until the EMG returned to baseline.

Results

There were no statistically significant differences in traction or recovery times between the left and right sides (p > 0.05). However, traction times significantly differed by cervical level (p < 0.001), with longer durations at C3/4 and C4/5. Recovery times also differed significantly by level (p < 0.001), with notably prolonged recovery at C6/7, where some nerves failed to return to baseline within 30 min.

Conclusion

These findings suggest that lower cervical levels, particularly C6/7, are more vulnerable to nerve damage, requiring heightened attention during ACSS. The study highlights the advantages of CIONM, including real-time detection of RLN stretch and its benefits during complex surgeries.

查看原文本刊更多论文

颈椎前路手术中连续术中神经监测系统对喉返神经的监测：猪模型研究

目的喉返神经（RLN）损伤是公认的颈椎前路手术（ACSS）的并发症，特别是在颈椎前路椎间盘切除术和融合（ACDF）中。本研究探讨了在猪ACSS模型中使用气管内肌电图（EMG）管进行持续术中神经生理监测（CIONM），重点关注牵回过程中的不良EMG信号事件以及手术水平和入路侧（左或右）RLN损伤和恢复的差异。材料与方法12只猪均采用配备肌电图的气管内插管。所有手术均经前路进行。分别评估两侧4节段（C3/4、C4/5、C5/6、C6/7）牵引所致RLN损伤。采用CIONM自动周期性刺激迷走神经，连续测量喉肌电图。在手术过程中，如果肌电图幅度下降超过50%或潜伏期增加超过10%，则设置警报激活，提示神经损伤。警报触发后，停止牵引，观察肌电图变化。记录牵引时间和恢复时间，直至肌电恢复基线。结果左右侧牵引和恢复时间差异无统计学意义(p >；0.05)。然而，牵引次数因颈椎水平而有显著差异(p <；0.001)， C3/4和C4/5的持续时间更长。不同水平的恢复时间也有显著差异(p <；0.001)， C6/7的恢复时间明显延长，其中一些神经未能在30分钟内恢复到基线。结论这些发现表明，较低的颈椎水平，特别是C6/7，更容易受到神经损伤，在ACSS期间需要高度关注。该研究强调了CIONM的优势，包括实时检测RLN拉伸及其在复杂手术中的益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.